Toddlers and Surgery (or... Adventures with my grandson's eye surgery)
Today was another pediatric learning day for me. My 3-1/2 year old grandson had strabissmus eye correction surgery. We prepared him as best we could ahead of time, including allowing any and all questions. I was surprised at the caliber of his questions:
When we got to the hospital (Primary Children's Hospital, in Salt Lake City), we found a very child-friendly facility. There were toys immediately available to the children as they arrive in the Outpatient Surgery area. And it was decorated in a way that was immediately welcoming to children and parents. Jonny immediately began playing. My daughter checked Jonny in, and was given a pager similar to the kind you get at a restaurant when waiting for a table. When it went off, she registered him, and then returned to the waiting area. A few minutes later, they were ready for Jonny to go to the pre-op area.
Jonny was assigned a room for pre-op vitals. Because he was familiar with having his BP and pulse ox checked, he had no issues with it at all. The nurse was pleasantly surprised. Some children have real issues with this. We got Jonny changed into his hospital pajamas, and we were escorted a few minutes later to the pre-op waiting room. There were several children waiting for surgery, all in pajamas. Some clung to their parents, but most were playing with the abundance of toys in the room. There was a nurse there that had tympanic thermometers (non-functional, but real), BP cuffs (functional), BVM masks, some of the odorant that the children could choose for their masks in the O.R., dolls to draw on and keep, and even small I.V. saline bags the children could all touch. Jonny chose to play with the BP cuff and tympanic thermometer. He decided *I* needed to have my vitals checked also, driving the tympanic thermometer to my brainstem, and putting the BP cuff on my wrist (it was a pediatric cuff), and pumping it up. He was remarkably calm. When the surgeon came out, Jonny knew him already, and was comfortable with him.
The anesthesiologist came out and spoke with Diana and myself, and then with Jonny. He got down on Jonny's level to talk to all of us. He explained how they would take all of us down the hall to the surgery area, then Jonny and us would have our hugs and kisses, and then he would take Jonny to the O.R. Diana told the anesthesiologist to use watermelon scent for Jonny. Jonny got a little clingy when we got up, and asked me to carry him, which of course I did. We gave Jonny hugs and kisses at the O.R. doors, and then the anesthesiologist took Jonny's hand, and he and Jonny went into the O.R. Jonny showed no fear at all as he walked in. The confidence and experience the anesthesiologist had with children was apparent with Jonny.
Roughly 45 minutes later, the surgeon came out and let us know that surgery had gone very well. He let us know that Jonny did not have the congenital abnormalities that my husband had (THANK GOD!), and that this was a good repair of Jonny's eyes. This surgery has an 85% success rate.
About 20 minutes later, Diana was escorted to post-op, and approximately 45 minutes later, I was. Jonny was still pretty groggy from anesthesia and more than a few doses of morphine for post-op pain. He couldn't tolerate light, so a wet washcloth was placed over his eyes while he recovered from anesthesia. Once he knew I was there, he started asking questions. And I answered them honestly. As I said, I learned a long time ago to NEVER LIE TO A CHILD ABOUT MEDICAL PROCEDURES.
Soon enough, it was time for us to leave. Jonny slept most of the trip home, which was delayed by a trip to a pharmacy for some narcotic pain reliever for Jonny. He had also been prescribed eye drops (antibiotic and steroid combination), which were given to us at the hospital. Jonny, once he woke up, was pretty much himself again. He even told us his eyes didn't hurt.
His first dose of eye drops was a reminder to me of how fear drives us. Jonny either remembered the first dose of drops in his eyes at the hospital (in the O.R.), or was just plain afraid of anything in or near his eyes. Diana and I had to physically restrain him to put the drops in. He complained that it hurt (which I do not doubt for a second). We got him a wet washcloth and laid it on his eyes, and gave him a dose of the Lortab elixir (mixed in Hershey's chocolate syrup to hide the bitterness). Soon enough, he was ok.
The second dose was even more difficult. But we got through it. Third dose also. Then yesterday I tried a new tactic. I explained to him that sometimes we have to take medicine we don't like, but that it was very important, and this medicine would help keep his eyes from getting sick, and would make his eyes feel even better in time. I told him we needed to put drops in once in a while. I even showed him the prescribing information (Yes, I know he can't read it), and explained that all the kids who had eye surgery had to take them. He told me he didn't want them until later and ran to his room and shut the door. Since he didn't need them for another hour, this was not a problem.
About 40 minutes later, he emerged and let me know he was ready for his drops. And I got a washcloth for him ahead of time. I put the drops in, and he let me know they didn't hurt! I praised him for being a big boy and for not getting upset. And reinforced it multiple times. I also told him he needed to tell his mommy he did the drops. He was so proud to tell her. And we now don't have a problem giving him the eye drops. They do hurt first thing in the morning (not sure why), but are easier with each dose during the day.
And so, it has been reinforced with me that honesty and reasoning work with a 3 year old. Both for the surgery, and for dealing with medications postoperatively. I was honest, his mom was honest, and the hospital staff was honest. Good take home message for all of us. Be honest with your patients, especially the pediatric patients. Lying to them only makes them mistrust you, or other healthcare providers.
- Are they taking my eyes out?
- Will I see?
- Will they cut my eye with a knife?
- Will it hurt?
- Will you be with me?
When we got to the hospital (Primary Children's Hospital, in Salt Lake City), we found a very child-friendly facility. There were toys immediately available to the children as they arrive in the Outpatient Surgery area. And it was decorated in a way that was immediately welcoming to children and parents. Jonny immediately began playing. My daughter checked Jonny in, and was given a pager similar to the kind you get at a restaurant when waiting for a table. When it went off, she registered him, and then returned to the waiting area. A few minutes later, they were ready for Jonny to go to the pre-op area.
Jonny was assigned a room for pre-op vitals. Because he was familiar with having his BP and pulse ox checked, he had no issues with it at all. The nurse was pleasantly surprised. Some children have real issues with this. We got Jonny changed into his hospital pajamas, and we were escorted a few minutes later to the pre-op waiting room. There were several children waiting for surgery, all in pajamas. Some clung to their parents, but most were playing with the abundance of toys in the room. There was a nurse there that had tympanic thermometers (non-functional, but real), BP cuffs (functional), BVM masks, some of the odorant that the children could choose for their masks in the O.R., dolls to draw on and keep, and even small I.V. saline bags the children could all touch. Jonny chose to play with the BP cuff and tympanic thermometer. He decided *I* needed to have my vitals checked also, driving the tympanic thermometer to my brainstem, and putting the BP cuff on my wrist (it was a pediatric cuff), and pumping it up. He was remarkably calm. When the surgeon came out, Jonny knew him already, and was comfortable with him.
The anesthesiologist came out and spoke with Diana and myself, and then with Jonny. He got down on Jonny's level to talk to all of us. He explained how they would take all of us down the hall to the surgery area, then Jonny and us would have our hugs and kisses, and then he would take Jonny to the O.R. Diana told the anesthesiologist to use watermelon scent for Jonny. Jonny got a little clingy when we got up, and asked me to carry him, which of course I did. We gave Jonny hugs and kisses at the O.R. doors, and then the anesthesiologist took Jonny's hand, and he and Jonny went into the O.R. Jonny showed no fear at all as he walked in. The confidence and experience the anesthesiologist had with children was apparent with Jonny.
Roughly 45 minutes later, the surgeon came out and let us know that surgery had gone very well. He let us know that Jonny did not have the congenital abnormalities that my husband had (THANK GOD!), and that this was a good repair of Jonny's eyes. This surgery has an 85% success rate.
About 20 minutes later, Diana was escorted to post-op, and approximately 45 minutes later, I was. Jonny was still pretty groggy from anesthesia and more than a few doses of morphine for post-op pain. He couldn't tolerate light, so a wet washcloth was placed over his eyes while he recovered from anesthesia. Once he knew I was there, he started asking questions. And I answered them honestly. As I said, I learned a long time ago to NEVER LIE TO A CHILD ABOUT MEDICAL PROCEDURES.
Soon enough, it was time for us to leave. Jonny slept most of the trip home, which was delayed by a trip to a pharmacy for some narcotic pain reliever for Jonny. He had also been prescribed eye drops (antibiotic and steroid combination), which were given to us at the hospital. Jonny, once he woke up, was pretty much himself again. He even told us his eyes didn't hurt.
His first dose of eye drops was a reminder to me of how fear drives us. Jonny either remembered the first dose of drops in his eyes at the hospital (in the O.R.), or was just plain afraid of anything in or near his eyes. Diana and I had to physically restrain him to put the drops in. He complained that it hurt (which I do not doubt for a second). We got him a wet washcloth and laid it on his eyes, and gave him a dose of the Lortab elixir (mixed in Hershey's chocolate syrup to hide the bitterness). Soon enough, he was ok.
The second dose was even more difficult. But we got through it. Third dose also. Then yesterday I tried a new tactic. I explained to him that sometimes we have to take medicine we don't like, but that it was very important, and this medicine would help keep his eyes from getting sick, and would make his eyes feel even better in time. I told him we needed to put drops in once in a while. I even showed him the prescribing information (Yes, I know he can't read it), and explained that all the kids who had eye surgery had to take them. He told me he didn't want them until later and ran to his room and shut the door. Since he didn't need them for another hour, this was not a problem.
About 40 minutes later, he emerged and let me know he was ready for his drops. And I got a washcloth for him ahead of time. I put the drops in, and he let me know they didn't hurt! I praised him for being a big boy and for not getting upset. And reinforced it multiple times. I also told him he needed to tell his mommy he did the drops. He was so proud to tell her. And we now don't have a problem giving him the eye drops. They do hurt first thing in the morning (not sure why), but are easier with each dose during the day.
And so, it has been reinforced with me that honesty and reasoning work with a 3 year old. Both for the surgery, and for dealing with medications postoperatively. I was honest, his mom was honest, and the hospital staff was honest. Good take home message for all of us. Be honest with your patients, especially the pediatric patients. Lying to them only makes them mistrust you, or other healthcare providers.
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